Wrist & Hand Pathologies Lecture 2 Flashcards
What is Rheumatoid Arthritis?
A chronic disease that involves recurrent inflammation resulting in damage to joints and soft tissues
Prevalence of RA
Approximately 0.24% of world population
Prevalence of RA amongst sex
Women are 3x more likely than men
What age is RA most likely to occur?
40-60 years old
Characteristics of joint findings in those with RA
Joint findings are typically symmetrical in the hands and feet
What parts of the muscles does RA commonly affect?
Commonly affects tendon sheaths
Subjective findings of RA (4/4)
Pain
Morning stiffness
Fatigue
Loss of function
Objecting findings of RA (pt 1: first 5 of 10 findings)
Heat Redness Swelling Ulnar drift Tendon crepitus
Objective findings of RA (pt 2: last 5 of 10 findings)
Swan-neck deformities Volar wrist subluxation Loss of grip (20 lbs for most ADLs) Loss of pinch (5-7 lbs for most ADLs) Loss of dexterity
Goals of management for RA (pt 1: first 4 of 7 goals)
Decrease pain
Decreasing swelling
Maintain joint mobility
Prevent or minimize joint deformity
Goals of management for RA (pt 2: last 3 of 7 goals)
Focus on joint systems rather than isolated joints
Consider health of the tissues in the hand generally
Maintain level of fitness
Medical management (early intervention) for RA
Medication (e.g. steroids)
4 methods of therapy intervention for RA
Orthoses
Exercise
Patient education
Possibly manual therapy
Orthoses use instructions for RA
As needed
The purpose of orthoses for RA
To stabilize painful joints and prevent further deformity development
What does the progressive exercise program consist of? (3/3)
AROM
Isometrics
General strengthening
Elements of patient education for those with RA (2/2)
Joint protection
Energy conservation
Acute stage presentation of RA (3/3 symptoms)
Active inflammation
Joint swelling
Redness and increased temperature
Describe the increase in pain associated with acute stage presentation of RA
Likely diffuse including the bilateral hands and feet
Acute stage management of RA (4/4)
Rest to decrease pain and swelling
Position to prevent contractures
Gentle ROM to maintain joint mobility
Modalities for pain control
Subacute stage management of RA (4/4)
Gradually increase activity level
Joint protection
Adaptive equipment
Manual therapy
Components of manual therapy used in the subacute stage of RA
Joint mobilization
STM
Chronic stage management of RA (3/3)
Joint protection
Progressive resistive exercise
Manual therapy
Reasons to include PREs in chronic stage management of RA
To increase strength and endurance
Types of PREs included in the chronic stage of RA?
Isometrics and pool therapy
Components of manual therapy used in the chronic stage of RA
Joint mobilization
STM
What does the triangular fibrocartilage do?
Stabilizes the distal ulna to the radius and carpus and transmits axial load from the hand to the forearm
How does the TFCC cushion against compressive forces?
It enhances joint congruity
How thick is the TFCC?
2-5 mm thick
What does the TFCC consist of (First 3/6)?
Articular disc
Dorsal/volar (palmar) radioulnar ligaments
Ulnar collateral ligament
What does the TFCC consist of (Last 3/6)?
ECU sheath
Ulnotriquetral ligament
Ulnolunate ligament
Mechanism of injury of TFCC (2/2)
Fall on supinated outstretched wrist/hand)
Chronic repetitive rotational loading
Types of TFCC classifications
Type 1: Traumatic (A-D)
Type 2: Degenerative (A-E)
Who primarily uses the classifications of TFCC and why?
Hand surgeons use them to identify surgical management
